Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring
Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring
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DOI：
10.1097/qad.0b013e32832e05b2
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发表时间：
2009-09-10
期刊：
影响因子：
3.8
通讯作者：
Egger, Matthias
中科院分区：
文献类型：
--
作者：
Keiser, Olivia;Tweya, Hannock;Egger, Matthias
背景资料：在高收入国家，常规测量病毒载量，以检测抗逆转录病毒疗法（ART）的失败，并指导转换到二线ART。在资源有限的环境中，通常无法进行病毒载量监测。我们研究切换从非核苷类逆转录酶抑制剂（NNRTI）为基础的一线方案，以蛋白酶催化剂为基础的方案在Africa，South America and Asia.Design and Methods：Multicohort study of 17 ART programmes。所有研究中心均监测了CD 4细胞计数并获得了二线ART，10个研究中心监测了病毒载量。我们比较了时间切换，CD 4细胞计数切换和获得调整后的风险比切换（aHR）与95%的置信区间（CI）从随机效应Weibull models.Results：共有20113例患者，包括6369（31.7%）患者从10个程序访问病毒载量监测，进行了分析; 576例（2.9%）切换。在所有方案中，ART启动时的低CD 4细胞计数与转换相关。在有病毒载量监测的项目中，转换的中位时间为16.3个月[四分位距（IQR）10.1-26.6]，在无病毒载量监测的项目中为21.8个月（IQR 14.0-21.8）（P
Background: In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia.Design and methods: Multicohort study of 17 ART programmes. All sites monitored CD4 cell count and had access to second-line ART and 10 sites monitored viral load. We compared times to switching, CD4 cell counts at switching and obtained adjusted hazard ratios for switching (aHRs) with 95% confidence intervals (CIs) from random-effects Weibull models.Results: A total of 20113 patients, including 6369 (31.7%) patients from 10 programmes with access to viral load monitoring, were analysed; 576 patients (2.9%) switched. Low CD4 cell counts at ART initiation were associated with switching in all programmes. Median time to switching was 16.3 months [interquartile range (IQR) 10.1-26.6] in programmes with viral load monitoring and 21.8 months (IQR 14.0-21.8) in programmes without viral load monitoring (P